'Consent in childbirth is a joke': How British women are silenced in the delivery room

The case of an American woman, who was unwillingly cut by doctors during
birth, has shocked many. But this problem isn't confined to the US, says Milli
Hill. British women find it just as hard to get their voices heard

Many women aren't aware they can say 'no' to certain procedures during birthPhoto: ALAMY

By Milli Hill

7:00AM BST 01 May 2015

Two years ago, in a California hospital, a woman named Kelly was told she needed an episiotomy while giving birth. Kelly questioned the decision to make the cut in her perineum – between her vagina and anus.

“I haven’t pushed yet”, she exclaimed. But the doctor approached her with scissors, saying, “I’m the expert here”.

Although the 27-year-old single mum had clearly said, “no, don’t cut me”, he proceeded to make twelve incisions anyway.

“Many of the lawyers we've spoken to are not sure whether a woman giving birth has the right to say, 'No,' to a medical procedure. And they don't see the dollar value in litigating this kind of a case, when they know that, just like them, any jury probably believes that the best outcome of childbirth is a live baby - irrespective of whether the mother has been maimed by her care providers in the process.

Determined to press ahead, Kelly (not her real name) has now decided to represent herself. She is crowdfunding and has already raised over seven thousand dollars.

According to Pascucci, Kelly feels the case is about the rights of all women: “Kelly represents countless women who have been silenced. She will not be silenced.”

Many women don't know they can refuse procedures (Alamy)

Kelly’s case is challenging attitudes in the US. But it would be a mistake to think the issue was confined to America.

Of course, in childbirth, decisions may have to be made quickly, but the law says that consent must still be obtained unless the woman is unable to make her wishes known, and if there is time, next-of-kin should be consulted.

These statistics are borne out anecdotally on forums and Facebook pages filled with stories from women who feel that they did not consent; were coerced into consent; or feel they were not given the information needed to make their consent valid.

Yet the right to choose is backed up by every UK professional body, including the NHS constitution, “You have the right to accept or refuse treatment that is offered to you, and not to be given any physical examination or treatment unless you have given valid consent.”

“Consent must be obtained”, agrees the Department of Health, “This principle reflects the right of patients to determine what happens to their own bodies.”

This is unsurprising, says Beverley Beech, chair of campaign groupAssociation for Improvements in Maternity Services (AIMS): “There is a huge issue about the narrow way choices are being presented to UK women. Either overtly or subtly, women are made to feel that if they don’t comply, something bad might happen to their baby.

“There is a doctor knows best attitude and women are very often not aware that they have rights. Those who are aware can find their protest falls on deaf ears.”

I easily found two British women who, like Kelly, had been given an episiotomy without their consent.

The first, who gave birth last week in Manchester, said that her refusal was overt: “The midwife gave no prior warning or explanation as to why she was doing it. I felt every second and was screaming at her to stop. She didn't even look at me or console me. She just carried on cutting.”

The second – now a trainee midwife – explained that her studies had prompted her to rethink her birth and wonder if much of the physical and emotional trauma was avoidable.

“I had several interventions, including an episiotomy that was not consented to. Nor do I now feel they were entirely necessary”, she told me.

“Even with procedures I did consent for, I wasn’t given proper information and didn’t fully understand the level of choice I had. I was just told, “Now we are going to do this.”

Others were happy to have the exams: “I knew I could refuse but didn’t - in all three of my labours I assumed that the trained midwife and/or consultant knew more about the safe way to deliver a baby than me.”

But many of the replies were troubling.

“I asked the doctor to stop, several times, and he didn't. Wish I had known then that I didn't have to consent”, commented one.

“Consent was neither sought nor given when I was in labour. I was in so much pain that I didn't consider the option of telling the staff no, although I wish I'd thought of it”, said another.

Others claimed their wishes weren’t respected: “I knew I could refuse. I put it in my birth plan. But that was never read. I was told they wouldn't admit me to the labour ward without one. Then later they just did them without my consent. Consent in childbirth is a joke.”

Several Mumsnetters told a similar story of feeling they had to agree to a VE to get admitted to hospital, or to access to birthing pools and pain relief.

“I was refused any pain relief or gas and air until I was examined. I felt very bullied”, said one.

Another wrote, “I knew I could refuse them. I was well aware that it was my body and that they needed my consent. But then when I was in labour and in pain and vulnerable and the midwife was saying I couldn't be admitted to the delivery suite unless I had a VE I gave in. Bottom line is that I didn't want her fingers in my vagina but I felt bullied into it.”

There were even women who had other procedures - such as membrane sweeps - without either their knowledge, or consent, during the VE.

The Duchess of Cambridge is due to give birth this week (Rex)

It’s not the first time I’ve heard such stories. But, as Jacque Gerrard, theRoyal College of Midwives Director for England points out, “We don’t have any statistical data about the prevalence of these cases.

Midwives need to remember that informed consent is crucial and a basic human right when providing safe high quality maternity care to our women”.

She found my Mumsnet discussion “worrying”.

“The national maternity review is about to commence and that is a real opportunity to try to improve maternity services and get them right for all women. We need to ensure that there are enough midwives so that each can give time to provide high-quality, safe antenatal care, while providing the opportunity for women to ask questions,” she added.

“It was midwives themselves who saw a need for change in maternity hospitals – a need for more dignity and respect for women and their choices – and took the lead.”

Dignity and respect for women’s choices is the key here.

To me, it’s a mistake to get sidetracked into arguments about the validity of procedures during labour. It doesn’t matter whether Kelly’s doctor thought he was making birth safer. It doesn’t matter what you think about VEs. It doesn’t even matter if you want a natural birth or an elective caesarean.

What’s important is that women have their right to choose – to consent – heard and respected.